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Concerns have been expressed relating to healthcare professionals' ability to manage deteriorating patients. Whilst on placement nursing students are exposed to a range of behaviours and role models that may influence their future practice. We aimed to identify events that impact upon the practice and preparedness of Australian undergraduate nursing students in the management of deteriorating patients. Methods included a Generic Qualitative Research design reviewing 224 reflective reports on clinical events submitted by 92 final year nursing students. Forty (40) patient deterioration events were identified and subjected to detailed coding and thematic analysis. A range of events impacted upon students' practice and preparation. Five themes and 15 subthemes were identified including ‘Communication’ - the need for adequate handover and documentation; ‘Teamwork’ - demonstrating the positive impact on patient outcomes; ‘Workload’ - the negative effects of high staff/patient ratios; ‘Clinical judgement/knowledge’ - the need for adequate preparation of staff for safe clinical settings; and negative outcomes relating to ‘Attention Deficits’. In conclusion Australian nursing students experience a range of practice behaviours from exemplary leadership, to careless individual practices and a ‘failure to rescue’ deteriorating patients. Clinical experiences have a profound influence on students with potential positive and negative effects on future practice. •Australian nursing students experience a range of practice and educational influences whilst on clinical placement highlighting the need for:oDevelopment of educational approaches and support mechanisms.oImproved management of deteriorating patients through:•Enhanced communication, exemplar teamwork, appropriate workload, improved knowledge, and a reduction in attention deficits.

Background Early clinical experience within a vertically integrated curriculum might contribute to the development of the desired competencies from the onset of studying medicine. However, most qualitative studies focused on the effects of early clinical experience on students were performed within a primary care setting in the second and third year of studies. Our aim was to explore, from the perspective of first-year medical students, the effects of an early clinical experience course in internal medicine within a tertiary hospital setting on their professional and personal development. Methods We used an inductive approach to conduct a conventional content analysis of 27 reflective writing reports written by first-year medical students after having completed a 60-hour early clinical experience course in the inpatient setting of a university hospital, comprising 48 h in the healthcare setting (primarily internal medicine and its subspecialties) and 12 h in team-building social events. Writing reports aimed to make students openly reflect on their course experience, elaborating on any aspect of perceived relevance. Results All 27 students invited to participate wrote a reflective report. We identified three themes with their respective categories of codes: (1) Professional growth, including formation of professional identity, dealing with emotions and experience with death; (2) Reinforcing motivation for further studies and work as a physician, including integration into medical studies, shaping a supporting environment and course as a highlight of the studies; and (3) Immersion into the medical field based on real-world exposure, including benefitting from early patient contact and exploration of the field of internal medicine. Throughout the reflective reports, role modelling appeared repeatedly as a driving element for the observed effects. Conclusions Our findings suggest that, from the perspective of first-year medical students, participation in an early clinical experience course in internal medicine within a tertiary hospital setting positively influences their initiation into professional growth, motivation for further studies and work as physician, and immersion in the medical profession. Further studies are needed to better understand the underlying success factors of such courses.

Purpose: Policy makers, professional associations and scholars continue to advocate for the integration of enhanced clinical experiences for future teachers' preparation. These recommendations reflect the growing recognition that few events in preservice teachers' education are more significant than their experiences in the classrooms of veteran peers. Aware of the fact that the field of teacher education needs examples of effective clinical experiences, the authors examined the \"critical, project-based\" (CPB) model, employing Photovoice activities in a dropout prevention course in a secondary education partner school at the beginning of the COVID-19 pandemic. This paper aims to discuss the aforementioned objective. Design/methodology/approach: Aware that the field of teacher education needs examples of effective clinical experiences, the authors examined the CPB model, employing Photovoice activities in a dropout prevention course in a secondary education partner school at the beginning of the COVID-19 pandemic. In this article they detail a practitioner research examination that explores the experiences of 12 preservice middle/high school teachers, reporting on these individuals' considerations of general pedagogies, writing instruction strategies and teaching personas. Findings: Results suggest that preservice teachers might best identify pedagogical practices that are consistent with their nascent teaching identities via experiences that occur in school-university partnerships in which future teachers are positioned as pedagogues. Originality/value: This manuscript explores the use of the \"CPB\" clinical experience model, identifying the impacts of this approach for preparing future teachers.

An essential component of the learning process for nursing and other disciplines in health professions education is the structuring of successful clinical experiences for beginning students. The purpose of this research study was to explore and describe first patient care experiences of baccalaureate nursing students in order to better understand student perspectives and perceptions. Data were collected from three cohorts of baccalaureate nursing in two university settings in the first semester following completion of first patient care experiences. A basic, exploratory qualitative approach with overtones of grounded theory was used for data collection and analysis. Three clear themes emerged from the data analysis. Participants experienced emotional responses of Anticipation, including fear, nervousness, and anxiety. The clinical experiences allowed Processing ∼ Working Through, which was impacted by actions of instructors, nurses and patients. Participants developed Awareness as a result of their experiences.

Chylous ascites and chylopleura due to constrictive pericarditis are rare and characterized by white milky ascites and pleural fluid. presence of chylomicrons Diagnosis is established by the However, the treatment of this situation is very difficult. We report a case ofchylous ascites and chylotborax, in which hydrops was attributable to constrictive pericarditis. In the present case, pericardiectomy combined with thoracic duct ligation and pleurodesis cured chylous ascites and cbylothorax caused by constrictive pericarditis, which has never been previously described.

Background Standardizing implementation of complex clinical outcome assessments (COAs) in Alzheimer’s disease (AD) clinical trials requires trained and qualified site raters. Best practices include setting minimum education and experience criteria, along with robust training programs. However, there is significant variability in the level of rigor applied to this process, often due to timeline and resource limitations. This study aimed to investigate the relation between raters’ experience and training performance and their in‐trial rater performance, as defined by remediations required during the trial. Method Data were analyzed from 160 raters across four AD clinical trials, including three countries and 70 sites. During startup, raters were categorized as fully qualified (via education, experience, and performance on applied scoring exercise) or sponsor exception (missing criteria but exempted into trial). Logistic regression was used to explore predictors of rater in‐trial performance (remediation during trial vs. no remediation). Predictors included 1) remediations during training, 2) rater qualification status, 3) AD clinical experience, and 4) AD research trial experience. Result Thirty‐eight (23.7%) of raters required remediation during trial. The average AD clinical experience was 108 months (SD=78 months), and average AD trials experience was 71 months (SD=52 months). Overall, the logistic regression model was significant c2 (4) = 20.6, p <.01, and remediation during training (B=1.91, SE=0.59, Wald=10.55, p <.001) and AD clinical experience (B= ‐0.01, SE=0.006, Wald = 6.68, p <.01) were significant predictors of remediation during trials. Conclusion These data confirm the importance of AD‐specific clinical experience and performance during pre‐trial training exercises as key indicators of rater performance during clinical trials. Sponsors should consider performance during pre‐trial startup activities when selecting raters to ensure that COAs are accurately scored and reliably implemented throughout the duration of the trial. Planned analyses will explore additional predictors of rater performance (e.g., individual and site level factors), as well as the implications of rater remediation on trial outcome data (i.e., impacts on data reliability).

This study investigates whether students with pre-matriculation, formalized, clinical experience performed better in Step 1 and Step 2 of the United States Medical Licensing Exams (USMLE) compared to students without formal pre-matriculation clinical experience. This research investigation was a retrospective cohort study conducted at the University of Arizona College of Medicine in Tucson, Arizona, USA, and analyzed students in the Class of 2017 and Class of 2018. Formal clinical experience was defined as registered nurses, physician assistants, nurse practitioners, paramedics, emergency medical technicians, or licensed practical nurses for any amount of time prior to matriculation, as well as scribing for at least 6 months prior to matriculation. Students with any amount of shadowing experience were not considered to have clinical experience. The authors performed multiple regression analyses to investigate the effects of formal clinical experience on USMLE exam performance. Statistical significance was defined as <0.05. All statistical analyses were performed using SAS 9.4. Our study had a total of 227 students from the two classes, with 40 (17.6%) having formal pre-matriculation clinical experience, as already defined. Nine (3.96%) students were not assessed in USMLE Step 1 calculations, and 61 (26.9%) students were not assessed in USMLE Step 2 calculations due to an absence of recorded USMLE scores. Formal pre-matriculation clinical experience was a statistically significant positive predictor of USMLE Step 1 score ( =0.03) and USMLE Step 2 score ( <0.010). Formal pre-matriculation clinical experience, as defined previously, positively correlates with an increase in USMLE Step 1 and Step 2 scores.

First-in-class drugs can be highly innovative because of their novel mechanisms of action, but they also carry uncertainty in the absence of clinical experience. To understand how such drugs advance through development to enter the market, we investigated Food and Drug Administration (FDA) approval data for 186 first-in-class drugs (2013-23) and data for 121 drugs approved by both the FDA and the European Medicines Agency (EMA; 2013-22), focusing on review durations, expedited program use, and characteristics of pivotal efficacy trials. The FDA applied substantial regulatory flexibility to first-in-class drugs, with 50 percent lacking clinical endpoints and 30 percent lacking blinding and comparator drugs in the pivotal trials. This flexibility was particularly evident in cancer drugs, for which up to 90 percent lacked clinical endpoints and blinding. The FDA designated 81 percent of firstin-class drugs for expedited programs compared with 30 percent designated by the EMA. Review durations varied by therapeutic area, ranging from 7.7 months to 14.5 months at the FDA, and were slightly slower at the EMA. Regulators need to carefully balance flexibilities with rigorous assessments of evidence for first-in-class drugs.

Background Academic burnout has a negative effect on learning outcomes of nursing students. Factors affecting academic burnout may differ depending on whether or not they have experience in clinical practice and identifying these differences would be necessary to seek for strategies to lower academic burnout of nursing students. This study aimed to determine the effects of stress, depression, and anxiety on academic burnout according to the clinical practice experience of nursing students. Methods Data were collected from 171 female nursing students in South Korea. Self-report questionnaires from 83 participants without clinical practice experience and 88 with clinical practice experience were analyzed using descriptive statistics, χ2-tests, analysis of variance, t-test, Spearman correlation coefficient, and stepwise multiple regression. Results Academic burnout was positively correlated to stress ( r  = .52, p  < .001), anxiety ( r  = .50, p  < .001) and depression ( r  = .44, p  < .001). In those students with no clinical practice experience, anxiety and depression explained for academic burnout by 44%, and those students with clinical practice experience, stress and major satisfaction explained for 33% of academic burnout. Conclusions Universities and clinical institutions should establish a cooperative system to reduce stress, depression and anxiety and increase major satisfaction.

The purpose of this study was to explore the relationship of baccalaureate nursing students’ (BSN) perceived learning effectiveness using the Clinical Learning Environments Comparison Survey of different levels of fidelity simulation and traditional clinical experiences. A convenience sample of 103 first semester BSN enrolled in a fundamental/assessment clinical course and 155 fifth semester BSN enrolled in a leadership clinical course participated in this study. A descriptive correlational design was used for this cross-sectional study to evaluate students’ perceptions after a simulation experience and the completion of the traditional clinical experiences. The subscales measured were communication, nursing leadership, and teaching-learning dyad. No statistical differences were noted based on the learning objectives. The communication subscale showed a tendency toward preference for traditional clinical experiences in meeting students perceived learning for communication. For student perceived learning effectiveness, faculty should determine the appropriate level of fidelity in simulation based on the learning objectives.